Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 002820 | GA |
NPI | 1023170602 |
---|---|
Provider Name | Mrs. Amy Boozer Moyer |
First Address | Augusta, GA 30907-3773 |
Second Address | Evans, GA 30809-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00650075D | (05) | GA |